Bush Chooses the F.D.A.'s Chief to Run Medicare and Medicaid

By ROBERT PEAR

Published: February 21, 2004

WASHINGTON, Feb. 20—
President Bush announced on Friday that he would nominate Dr. Mark B. McClellan, the food and drug commissioner, to run Medicare and Medicaid, the health insurance programs for more than 70 million Americans.

Dr. McClellan faces a huge logistical and political challenge: to provide prescription drug coverage to the elderly while fending off Democratic attacks on the new Medicare law, which Mr. Bush sees as his greatest achievement in domestic policy.

If confirmed by the Senate, Dr. McClellan will become administrator of the Centers for Medicare and Medicaid Services, which spends more than $480 billion a year and regulates nearly every sector of the nation's health care system.

While firmly committed to the president's free-market policies, Dr. McClellan has shown a knack for working with members of both parties in a pragmatic way that blends science, economics and politics.

Dr. McClellan, a physician and economist, has received rave reviews from drug companies for his work as chief of the Food and Drug Administration, a post he assumed in November 2002. He served earlier at the White House, as health policy coordinator and a member of Mr. Bush's Council of Economic Advisers. In the Clinton administration, he worked on domestic policy, as a deputy assistant secretary of the Treasury in 1998-99.

Dr. McClellan, 40, will need all that expertise and more to carry out the new Medicare law successfully.

Under that law, Medicare beneficiaries can obtain drug discount cards this June and full-fledged drug benefits starting in January 2006. But the law also gives private health insurance plans a big new role in Medicare, and Democrats, who attack the legislation as overly generous to pharmaceutical and insurance companies, want sweeping changes, which the administration is resisting. As commissioner of food and drugs, Dr. McClellan has tried to stamp out, on safety grounds, a wave of support for allowing imports of lower-cost prescription drugs from Canada.

Dr. McClellan is the brother of the White House press secretary, Scott McClellan, and a son of the Texas comptroller, Carole Keeton Strayhorn, who has hinted that she may run for governor in two years.

Senator Edward M. Kennedy, Democrat of Massachusetts, said Dr. McClellan was ''a superb choice.'' Senator Max Baucus of Montana, the senior Democrat on the Senate Finance Committee, which oversees both Medicare and Medicaid, said: ''Dr. McClellan was an expert resource throughout last year's Medicare prescription drug negotiations. I found him to be a straight shooter who doesn't allow politics to get in the way of good policy.''

Mr. Baucus predicted that the nomination would be confirmed ''without a hitch.''

Representative Henry A. Waxman, a California Democrat who has long worked on health legislation, said, ''Mark McClellan is a very able individual, but he will have a difficult job defending and implementing the inadequate, ill-conceived prescription drug law passed by this Republican Congress.''

Republicans expect the law to pay political dividends. But they have spent the last 10 weeks defending it against criticism from Democrats who say it is wholly inadequate to meet the needs of America's elderly.

If Dr. McClellan is confirmed, his deputy, Dr. Lester M. Crawford, will become acting commissioner of food and drugs. Peter J. Pitts, a spokesman for the F.D.A., said its policies would continue unchanged.